Abstract:
:Clinical epidemiology is sometimes called the basic science of clinical medicine. In terms of the pathogenesis of testicular germ cell tumors (GCTs), clinical epidemiology analyzes suspected risk factors. The present review highlights the risk factors established so far and briefly summarizes those factors currently under investigation. In analogy to the methods of evidence based medicine, this review attributes levels of evidence to each of the putative risk factors. Level I represents highest quality of evidence while level V denotes the lowest level. So far, undescended testis (UDT), contralateral testicular GCT and familial testis cancer are established risk factors attaining high levels of evidence (levels I-III a). In a meta-analysis of 21 studies exploring the association of UDT with GCT risk, an over-all relative risk (RR) of 4.8 (95% confidence interval 4.0-5.7) was found. Contralateral testicular GCT involves a roughly 25-fold increased RR of GCT, while familial testis cancer constitutes a RR of 3-10. Infertility, testicular atrophy, and twin-ship represent risk factors with lesser levels of evidence (level III a). There is also some evidence for HIV infection being a predisposing factor for GCT (level IV a). Scrotal trauma is probably not associated with GCT risk. The estrogen excess theory implies high estrogen levels during the first trimester of pregnancy. As a consequence, primordial germ cells lose track of the normal developmental line and transform into premalignant cells that later become testicular intraepithelial neoplasia (TIN), the precursor of full-blown testicular GCT. Surrogate parameters for high gestational estrogen levels are investigated in case control studies. Such factors are maternal age >30 years, first-born, low birth weight, maternal breast cancer, high sex-ratio of siblings. So far, the sum of evidence is promising but still conflicting (especially for level III b). Another novel theory is the childhood nutrition hypothesis. This concept postulates a modulating or "catalyzing" effect by high dietary intake during childhood on the pathogenesis of testicular GCT. A surrogate parameter of early childhood nutrition is adult height. So far, 12 controlled studies have looked to the possible association of attained height and GCT risk of which six demonstrated a significant association. Thus, the sum of evidence corresponds to level III b. This concept is appealing because it would explain several hitherto unexplained epidemiological features of GCT.
journal_name
World J Uroljournal_title
World journal of urologyauthors
Dieckmann KP,Pichlmeier Udoi
10.1007/s00345-004-0398-8keywords:
subject
Has Abstractpub_date
2004-04-01 00:00:00pages
2-14issue
1eissn
0724-4983issn
1433-8726journal_volume
22pub_type
杂志文章,评审abstract:PURPOSE:Previous studies of the cell cycle progression (CCP) score in surgical specimens of prostate cancer (PCa) in patients treated by radical prostatectomy (RP) demonstrated significant association with time to biochemical recurrence (BCR). In this study, we compared the ability of the CCP score and the expression o...
journal_title:World journal of urology
pub_type: 杂志文章,多中心研究
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更新日期:2018-09-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章
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journal_title:World journal of urology
pub_type: 杂志文章
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更新日期:2019-11-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章
doi:10.1007/s00345-018-2303-x
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journal_title:World journal of urology
pub_type: 杂志文章
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更新日期:2008-10-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章
doi:10.1007/s00345-019-02835-2
更新日期:2020-04-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章,评审
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更新日期:2002-04-01 00:00:00
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journal_title:World journal of urology
pub_type: 已发布勘误
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更新日期:2020-09-01 00:00:00
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pub_type: 杂志文章
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更新日期:2020-11-11 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章
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更新日期:2020-04-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章
doi:10.1007/s00345-019-02856-x
更新日期:2020-03-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章
doi:10.1007/s00345-019-02873-w
更新日期:2019-12-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章
doi:10.1007/s00345-020-03409-3
更新日期:2020-08-31 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章
doi:10.1007/s00345-018-2187-9
更新日期:2018-05-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章,随机对照试验
doi:10.1007/s00345-008-0258-z
更新日期:2008-08-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章,评审
doi:10.1007/s00345-007-0158-7
更新日期:2007-04-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章
doi:10.1007/s00345-009-0386-0
更新日期:2009-10-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章,已发布勘误
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更新日期:2020-06-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章,随机对照试验
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更新日期:2015-09-01 00:00:00
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journal_title:World journal of urology
pub_type: 临床试验,杂志文章
doi:10.1007/BF00184874
更新日期:1995-01-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章
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更新日期:2011-04-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章,评审
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更新日期:2004-06-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章
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更新日期:2011-08-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章
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更新日期:2020-04-06 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章,收录出版
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更新日期:2007-12-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章
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更新日期:2010-02-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章,评审
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更新日期:2013-08-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章
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更新日期:2020-07-12 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章
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更新日期:2020-06-01 00:00:00
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journal_title:World journal of urology
pub_type: 杂志文章
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更新日期:2020-09-01 00:00:00